Ketoacidosis - nnukwu ọrịa shuga

Ketoacidosis bụ nsogbu siri ike nke ọrịa shuga na-ebilite na enweghị insulin. Ogwu aria na - egbu ndu, nihi na precomatous steeti abanyela n’ihu, ma cma. Enweghị nlekọta mberede ga-eduga ọnwụ. Nsogbu yiri nke ahụ nwere ike ibilite na ụmụaka na ndị okenye nwere ọrịa shuga 1, n'agbanyeghị ụdị ọrịa shuga 2, a naghị achọpụta ketoacidosis.

Ihe kpatara

Ketoacidosis na-etolite na enweghi insulin, ma oburu na aru apughi iji glucose ma jiri ya mee ihe maka ike. N'ihi ya, ihe a na-achịkọbara n’ọbara. Ebe ọ bụ na mkpụrụ ndụ na-enwe agụụ agụụ, a na-eji usoro ịkwụ ụgwọ na-arụ ọrụ, anụ ahụ na-achọkwa inweta ume site na ịkụda egbugbere ọnụ.

Usoro ahụ bụ njikọ nke ketone, nke na-agbakọta n'ime ọbara. A na - akpọ pathology yiri "ketosis." Akụrụ enweghị ike iwepu ọtụtụ ihe unyi nke emechara ka acetone. Acidosis na - etolite, ọ na - ebute ihe egbu egbu nke ahụ. Ọdịdị alkaline nke ọbara na-agbadata n'okpuru 7.3 pH, acidity ya na-abawanye (a na-atụle uru nkịtị nke 7.35-7.45 pH dị ka ihe kwesịrị ekwesị).

E nwere ogo 3 nke ketoacidosis:

1. Dị Mfe. Ihe ịrịba ama nke mbụ egbu egbu pụtara - ọgbụgbọ. Mmetụta ure na-abụkarị ọnya (ọrịa shuga), ikuku ekuru amalite na-esi isi ka acetone.
2. Ọkara. Ọnọdụ ahụ na-akawanye njọ, afọ na-afụ ụfụ, onye ahụ na-arịa ọrịa. A na-achọpụta mmebi nke usoro obi: na-ebelata ọbara mgbali elu, mmụba obi na-aba ụba (site na 90 gbagwojuru kwa nkeji).
3. Ike. Iche iche na-emebi emebi, ụmụ akwụkwọ ahụ na-etelata, na-akwụsị ịzaghachi ọkụ. Ahụ na-egbu ahụ. Isi nke acetone na-agbasi ike, a na-ahụ ya ngwa ngwa n’ime ụlọ ebe onye ọrịa nọ.

Ihe na - akpata ketoacidosis gụnyere:

• Mmalite nke ụdị ọrịa shuga 1 (ya na ọrịa a na-enyochaghị);
• Nlekọta adịghị mma nke ọrịa shuga na-akpata insulin (ịgbakọ ọ̀gaghị uru, ịchịkwa insulin n'oge, njehie na nri);
• Ojiji nke ndị ọrịa hypoglycemic emebiela ma ọ bụ ọgwụ echekwara na-ekwesịghị ekwesị;
• Ọgwụ ịwa ahụ;
• Mmerụ ahụ
• Nchegbu
• Usoro ogologo oge nke ọrịa shuga na-abụghị insulin, tinyere ụkọ insulin;
• Ime
• Drugsakingụ ọgwụ nke na-emebi mmetụta nke insulin (dịka ọmụmaatụ corticosteroids, diuretics, homonụ).

Ọrịa shuga na-emebi ọrịa ụfọdụ: ọrịa nke akụkụ okuku ume, sistemụ urinary, ọrịa na-adịghị ala ala, nkụchi obi, ọrịa strok. Ketoacidosis na ụmụaka na-abụkarị n'ihi ọrịa shuga na-akpata insulin na-achọpụtaghị (yana ngosipụta mbụ nke ọrịa ahụ), a na-ebute ikpe na-esote site na njehie na usoro ọgwụgwọ.

Ọrịa

Ọrịa Pathology na-amalite ngwa ngwa, oge ihe a na-eme sitere na 1 ruo ọtụtụ ụbọchị. Ihe ịrịba ama nke mbụ nke ketoacidosis bụ n'ihi mmụba nke glucose n'ihi ọkwa insulin ezughị ezu.

Ndị a gụnyere:

• Akpịrị ịkpọ nkụ;
• Adịghị Ike
• Urinjọ ngwa ngwa;
• Anụ akọrọ, akpụkpọ anụ mucous.

Enwere akara nke ketosis, acidosis: vomiting, ọgbụgbọ, afọ na-amalite imerụ ahụ. Ọ na-esi acetone a na-esi ya n'ọnụ. Ibe mmiri na-eduga na nkụda mmụọ nke etiti, nke njiri mara na-ekpebisi ike:

• Mgbu n’isi;
• Harhapụ;
• Mmeghachi omume nwayọ;
• Rowsjọ
• Iwe.

Na enweghị enyemaka zuru oke, coma na-eme, dysfunction akụkụ iku ume na amalite. Kwụsị iku ume, obi na-akpata ọnwụ.

Ọrịa nke ketoacidosis n'ime ụmụaka yiri nnabata nke pathology na ndị okenye. Ọnọdụ yiri nke a na otu ndị ọrịa bụkwa otu n'ime ihe ndị kasị njọ nsonaazụ shuga. Ketoacidosis bụ otu n'ime ihe na-akpata ọnwụ na ụmụaka nwere ọrịa a.

Ihe ị ga-eme

A na-adụ ndị ọrịa shuga ume ịzụta mita glucose ọbara na mpempe ule iji chọpụta ahụ ketone na mmamịrị. Ọ bụrụ na ngosipụta abụọ ahụ dị elu, yana mgbaama egosipụtara n’elu, ịkwesịrị ịkpọ ụgbọ ihe mberede. A ga-akpọrịrị onye ọrịa n'ụlọ ọgwụ ma ọ bụrụ na onye ahụ nwere nnukwu adịghị ike, mmiri gwụ, ma nweekwa mmụọ.

Ezigbo ihe mere eji akpọ ụgbọ ihe mberede:

• Mgbu n’azụ sternum;
• Vomiting
• Mgbu afọ;
• Mmụba a na-enwe okpomọkụ (site na 38.3 Celsius);
• Ọkwa shuga dị elu, ebe onye gosipụtara anabataghị ihe achọrọ n'ụlọ.

Cheta na emegaghị ma ọ bụ ọgwụgwọ adịghị egbu egbu na-egbukarị.

Diagnostics

Tupu itinye onye ọrịa n'ụlọ ọgwụ, a na-eme nnwale ngwa ngwa maka ọkwa glucose na ketone n'ime ọbara, mmamịrị. Mgbe ị na-achọpụta nyocha, nsonaazụ nke nnwale ọbara iji chọpụta ọkwa nke electrolytes (potassium, sodium, wdg). Nwa pH nke ọbara na-eme atụmatụ.

Iji chọpụta ọnọdụ ọrịa ndị ọzọ, mee usoro nchọpụta ọrịa ndị a:

• Nnyocha nyocha;
• ECG
• X-ray.

Oge ụfọdụ ịkwesịrị ime nyocha nke ụbụrụ. Ọ dị mkpa ikpebi ogo ketoacidosis na ọdịiche dị iche na ọnọdụ ndị ọzọ:

• Agụụ "ketosis;
• Lactic acidosis (ngafe nke lactic acid);
• Mmanya ketoacidosis;
• ọgwụ aspirin;
• nsị ethanol, methanol.

N'ọnọdụ ndị a na-enyo enyo na ọria, mmepe nke ọrịa ndị ọzọ, a na-eme nyocha ndị ọzọ.

Ọgwụgwọ

Treatmentgwọ ọrịa nke usoro ketosis na-amalite site na mkpochapu ihe ndị na-akpasu ya iwe. Nchịkọta menu na-amachi abụba. Emere onye ọrịa ahụ ihe ọkalụ alụ alkaline (mmiri soda, mmiri alkaline ịnweta, Regidron).

Ha na-akwado ị takingụ ọgwụ enterosorbents, hepatoprotector. Ọ bụrụ na ahụ adịchaghị onye ọrịa ahụ mma, a na-edenye ọgwụ insulin ọzọ “ngwa ngwa”, usoro ịgba ọgwụ insulin siri ike na-enyekwa aka.

B nwere ike ọ ga-eji mee ihe ọfụma

Usoro ọgwụgwọ Ketoacidosis

A na-eme ọgwụgwọ nke ketoacidosis n'ụlọ ọgwụ. Ebumnuche bụ isi bụ ịhazi ọkwa insulin. Usoro ọgwụgwọ gụnyere 5 nkebi:

• Usoro ọgwụgwọ insulin;
• Njikwa akpịrị ịkpọ nkụ;
• Ntughari nke enweghi ahihia, sodium;
• Symptomatic ọgwụgwọ nke acidosis;
• Ọgwụ nke concomitant pathologies.

A na-elekọta insulin n'ime intraven, na-eji usoro nke obere usoro, nke kachasị nchebe. Ọ mejupụtara na insulọn kwa elekere n'ime nkeji 4-10. Obere usoro na-enyere aka belata usoro ọgbụgba, na-egbu oge iwepụ glucose n'ime ọbara, ma melite nguzobe nke glycogen. A choro ilegide shuga shuga.

A na-eme ntụpọ sodium chloride, a na-achịkwa potassium mgbe niile (ego kwa ụbọchị ekwesịghị gafere 15-20 g). Ihe ngosi ọkwa nke potassium kwesịrị ịdị 4-5 meq / l. N’ime awa iri na abụọ izizi, ngụkọta nke mmiri a gbanyere n’arịa ekwesịghị ịbụ ihe dị ka 10% n’arụ nke onye ọrịa, ma ọ bụghị n’ihe ize ndụ nke mbufụt ure na-abawanye.

Site na ọgbụgbọ, a na-eme larịị gastric. Ọ bụrụ na mmịpụta ahụ apụta, a na-ejikọta onye ọrịa ahụ na onye na-ekuru ikuku. Nke a ga - egbochi imerime umeji.

A na-eme ọgwụgwọ maka iwepụ acidity ọbara, agbanyeghị, ewepụtara sodium bicarbonate naanị ma ọ bụrụ na pH ọbara erughị 7.0. Iji gbochie ọbara ọgbụgba, a na-enyekwa ọgwụ heparin ọzọ.

A na-elebara anya na ọgwụgwọ nke ọrịa ndị ọzọ nwere ike ibute mmepe nke coma (trauma, oyi baa, wdg). Iji gbochie ọrịa na-efe efe, a na-eji ọgwụ intramuscular ọgwụ penicillin mee ihe. Site na mmepe nke ọrịa, a na-ejikọ ọgwụ mgbochi kwesịrị ekwesị na ọgwụgwọ ahụ. Ọ bụrụ na ọrịa ụbụrụ emepụtara, ọgwụgwọ corticosteroids, akwara dị mkpa, a na-emekwa ikuku nke ikuku.

E mepụtara ọnọdụ kachasị mma maka onye ọrịa, nke gụnyere onu ọcha, akpụkpọ ahụ. Ndị ọrịa mamịrị nwere ketoacidosis chọrọ nlere anya oge niile. A na-enyocha ihe ndị a na-egosi:

• Nnyocha nyocha nke mmamịrị, ọbara (mgbe a nabatara n'ụlọ ọgwụ, na mgbe ahụ - na nkeji nke ụbọchị 2-3);
• Nnwale ọbara dị ngwa maka shuga (kwa awa, na mgbe shuga ruru 13-14 mmol / l - na nkeji nke awa 3);
• Nyochaa acineone maka acetone (na ụbọchị abụọ mbụ - 2 p / ụbọchị, emesịa - 1 p / ụbọchị);
• Mkpebi ọkwa nke sodium, potassium (2 p. / Day);
• Nyocha nke ọkwa phosphorus (ọ bụrụ na ọrịa ahụ gwụrụ n'ihi nri na-edozi ahụ);
• Mkpebi ọbara pH, hematocrit (1-2 p. / Day);
• Mkpebi nke nitrogen, creatinine, urea;
• Nyochaa oke mmamịrị ewepụtara (kwa oge ruo mgbe a ga-eweghachi usoro mmụkọ nkịtị);
• Nnwale nrụgide nke akwara;
• Nlegide anya ECG, onodu obi, obara, otutu.

A na-eme ọgwụgwọ nke ketoacidosis n'ime ụmụaka dịka atụmatụ ọzọ si dị, gụnyere: injections insulin nke "ngwa ngwa", iwebata ọgwụgwọ physiological, calcium, alkalization nke ọbara. Mgbe ụfọdụ, a chọrọ heparin. Mgbe okpomoku di elu, eji ogwu agha ya na otutu ihe eji eme ya.

Oriri na-edozi ahụ maka ketocacidosis

Ihe oriri na-edozi ahụ na-emetụta ogo ọnọdụ onye ọrịa ahụ. Ihe oriri maka onye na-arịa ọrịa shuga na steeti predomatous ekwesịghị ịnwe abụba, a na-ewepụ ha maka ụbọchị 7-10. Nri nwere protein bara ụba nwere oke, yana ịgbakwunye carbohydrates digestible (mana ọ bụghị shuga). Ejiri sorbitol, xylitol, ha nwere ngwongwo antiketogenic. Ka emechara usoro ahụ, a na-ahapụ ya ka abụba abụba, mana ọ bụghị tupu tupu ụbọchị iri. Ha na-eji nwayọ abanye na menu nke ọ na-emebu.

Ọ bụrụ na onye ọrịa enweghị ike iri nri nke aka ya, a na-ewepụta parenteral mmiri, a ga - eme glucose (5%). Mgbe nkwalite gasịchara, menu gụnyere:

• 1stbọchị nke mbụ: carbohydrates dị omimi (semolina, mmanụ a ,ụ, jam), ihe ọ drinkụ drinkụ buru ibu (ihe ruru 1.5-3 lita), mmiri mmiri alkaline (dịka, Borjomi);
• 2ndbọchị nke abụọ: oatmeal, poteto achara, mmiri ara ehi, ngwaahịa mmiri ara ehi, achịcha a na-eme achịcha;
• 3rdbọchị nke atọ: a na-ewebata efere, mashed anụ ọzọ na nri.

N’ụbọchị atọ mbụ ka akpịrị na-apụ, a na-ewepu protein ụmụ anụmanụ na menu. Ha na-aghọrọ nri oriri na-edozi ahụ n'ime otu izu, mana abụba ga - abụrịrịrịrịrịrị ruo mgbe a ga - akwụ ụgwọ ọnọdụ.

Mgbochi Ketoacidosis

Nnabata na ihe mgbochi ga - egbochi ketoacidosis. Ndị a gụnyere:

1. Ojiji nke insulin kwekọrọ na shuga;
2. Nyochaa glucose nke ọbara (iji glucometer);
3. Ojiji nke nnwale iji chọpụta ketone;
4. -Mata nnabata nke steeti iji ghazie idozi onodu hypoglycemic;
5. Ingga akwụkwọ maka ndị ọrịa mamịrị.

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